During the past 10 years from 1963 to 1972, a total 20 cases of the pseudocysts of the pancreas were treated surgically and the present report is a review of clinical findings in this group of patients.
The pseudocysts of the pancreas are the rare condition in the general ward, as 0.007 percent of 2,143, 631 admissions in Howard and Jordan´s series and 0. 19 percent of all general surgical cases in Hwang´s series.
As the etiologic factors of the pseudocysts of the pancreas, the acute or chronic pancreatitis, trauma, and neoplasm are generally accepted. But the idiopathic form of the pseudocyst which develops without previous history of pancreatic disease or injury is also suggested. In our experience, trauma as an etiology is much more common than others.
These pseudocysts usually appear as the tender mass, most commonly in the upper abdomen in about three fourths of the cases, and most commonly give rise to symptoms such as abdominal pain in 12 cases, indigestion in 4 cases, nausea and ´vomiting in 3 cases, and weight loss in 2 cases. Besides those symptoms, they have jaundice and hydrothorax in a case, respectively.
In the diagnosis of the pseudocysts of the pancreas, roentgenologic studies are most helpful. In. 8 of 11 cases, U.G.I. series shows compression and displacement of the stomach and/or the: duodenum by an extrinsic mass, and in 8 of 10 cases, barium enema shows the downwardt displacement of the splenic flexure of the transverse colon. Leukocytosis is noted in 11 of 20 cases, and the serum amylase ranged 257 Somogyi units to 780 Somogyi units in 5 of 9 cases.
External drainage are performed in 4 cases: Simple drainage in 3 cases and marsupialization in a case of spontaneous perforation of the pseudocyst.
. Internal drainage are performed in 17 cases, including a case of reoperation due to recurrence of the pseudocyst after performing the cystogastrostomy: Cystogastrostomy in 6 cases, Roux-en-Y cystojejunostomy, and Cystojejunostomy in 5 cases, respectively, and a case of Cystoduodenostomy.
Complications of the pseudocysts are noted in 4 cases, such as infection of the pseudocyst in 2 cases, spontaneous perforation of the pseudocyst, and obstructive jaundice in a case, respectively.
Of 21 operative procedurse, there are 8 complications and a death. Main wound infection is noted in 4 cases, and pancreatic fistula developed in 2 cases. Recurrence of the pseudocyst and intestinal obstruction developed in a case, respectively.
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